Is the AIDS epidemic declining?

Jun 19, 1998

Mr Sowadsky:

Could you please comment on the latest numbers from the recent issue (June 9) of the HIV/AIDS Surveillance Report, the CDC's publication that tracks the epidemic. Given the continued drop in new cases, when could we conclude that this epidemic is now officially on the natural downturn that characterizes all epidemics? In fact, is it misleading to refer to AIDS as an "epidemic" in the USA, given most people's concept of this term?

Year-end HIV/AIDS 1997 AIDS report finally in. Highlights:

* Overall, cases declined from 68,808 in 1996 to 60,634 in 1997.

* Heterosexual contact cases declined from 9,526 in 1996 to 8,112 in 1997. In 1996 they were 14 percent of all cases; in 1997 they were 13 percent.

* Female adult cases declined from 13,767 to 13,105.

* Pediatric cases declined from 671 to 473. Of these, all but 63 were racial/ethnic minorities.

Response from Mr. Sowadsky

Thank you for your question. Many people (including many members of the media) have misinterpreted many of the statistics found in the June 1998 edition of the HIVAIDS Surveillance Report. Let me clear up some of the confusion. As you will see, not only is the epidemic not ending, the number of people living with the virus may actually be going up, both in the USA, and especially worldwide!

The cause of much of the confusion is how statistics are collected in the USA, and what the statistics mean. If you look at the statistics in the report, you will clearly see that the number of people diagnosed with AIDS is going down each year. There is no doubt about that. However, the statistics you are reading are for people diagnosed with full-blown AIDS, not those with the HIV virus (who do not yet have AIDS). Let me explain the difference.

In the United States, AIDS has been a reportable disease since 1981. AIDS is reportable in all US states and territories. The average period of time from infection with the HIV virus to a diagnosis of AIDS, is approximately 10 years. In other words, a person infected with HIV will not be counted in the national statistics, until an average of 10 years after they are infected. When you are reading AIDS statistics (how many new cases there are, who is getting it, etc.), what you are reading is the scope of the epidemic an average of 10 years ago. Because of improved treatments, people are now living longer, and we are now able to slow down the progression of the disease (in many cases) better than before. This is why you are seeing a significant decrease in the number of new cases of AIDS each year.

To determine the scope of the epidemic today, you have to look at HIV statistics, not AIDS statistics. HIV statistics tell us what is happening today (how many new cases there are, who is getting it, etc.), rather than 10 years ago. However, when it comes to HIV statistics, we have a major problem. Having HIV (but not yet being diagnosed with full-blown AIDS) is only reportable in approximately 30 of the 50 states. And large population states like New York and California do not presently have HIV reporting. Therefore we can only estimate the number of new cases of HIV infection today. Any statistics you see for HIV cases in the USA are significantly under-reported. For the limited number of states having HIV reporting, preliminary data indicates that the number of new infections with HIV is remaining relatively stable each year. It is not going down. For more information on the number of new cases of HIV in the United States, let me refer you to the following report:

Diagnosis and Reporting of HIV and AIDS in states with Integrated HIV and AIDS Surveillance--United States, January 1994-June 1997

Morbidity and Mortality Weekly Report

April 24, 1998

Vol. 47 #15

When we combine the number of cases of new HIV infections (which is remaining relatively stable each year), with the number of people living with AIDS (who are now living longer), the TOTAL number of people living with the virus (HIV cases plus AIDS cases) may actually be going up. There are now more and more people living with the virus. So although the number of new cases of full-blown AIDS is going down each year, the number of people living with the HIV virus, overall, may actually be going up.

When we are looking at the scope of the epidemic worldwide, the latest estimates show that the epidemic is worse than previously thought. For more information on the scope of the epidemic worldwide, let me refer you to the following report:

Report on the Global HIV/AIDS Epidemic

World Health Organization

December 1997

In summary, when you are reading any statistics, you must carefully read whether the statistics are referring to HIV cases or AIDS cases. It is very easy to confuse the two. Remember, HIV statistics tell us the scope of the epidemic today. AIDS statistics tell us the scope of the epidemic an average of 10 years ago.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).

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